Book explores long-term care’s challenges, opportunities

Reviewed by James K. Luiselli, Ed.D., ABPP, BCBA-D

Historically, mental health professionals, including psychologists, have had limited roles in long-term care settings for older adults. However, geropsychology has become an active discipline and represents solid ground for innovative practice and research inquiry.

Written by two psychologists, this book encourages mental health professionals to expand service options within nursing homes, assisted living facilities and other long-term care settings.

It provides a wealth of information for any practitioner involved with or contemplating practice with older adults living in specialized programs that address their cognitive, medical, psychiatric, and behavioral needs.

The authors decided to focus on “long-term care settings that are more institutional and/or facility based, as these settings have greater influence over the day-to-day experiences of the older adults who live there.” I note that the book is equally applicable to most long-term care priorities regardless of specific setting.

The literature reviewed in the book, quite broad and extensive, is largely based on research and best practices for skilled nursing care. The authors point out that “skilled care residents generally have high levels of medical acuity, significant functional challenges and in many cases, co-morbid mental health and neurocognitive disorders.”

Typically, mental health professionals have confined their work in long-term care settings to assessment and therapy. This book argues persuasively for a larger role that can influence culture, organizational policies and overall resident care beyond the scope of traditional mental health services.

The first part of the book explains the current status of conventional long-term care, detailing the complex area of regulatory oversight, diverse needs of the resident population, priorities for personnel training and perplexing standards of cost reimbursement.

The authors make clear that these are just some of the challenges mental health professionals face and must overcome in delivering long-term care services.

Part two of the book presents a vision for long-term care and the evolving contributions of mental health professionals. The central topics that the authors cover are person-centered support plans, environmental modifications, non-pharmacologic interventions and multidisciplinary collaboration.

They further suggest ways that mental health professionals can use their training and expertise to introduce new and creative approaches to different long-term care settings.

A highlight of the book is the final chapter which describes the Eldercare Model, developed by the first author, as a comprehensive therapeutic approach geared towards long-term care settings. This model integrates “traditional mental health services with consultation, training, and behavior management services” to affect desirable systems-level change and numerous quality of life indicators.

“Transforming Long-Term Care” looks intensely at geropsychology by acknowledging some of the limitations posed by these settings, while revealing many opportunities afforded to mental health professionals. The authors are evidence-based clinicians who advocate a scientist-practitioner philosophy that is evident throughout the book.

The authors also write with compassion and sensitivity, in their words, “to assist in changing hearts, minds and systems within long-term care so that the older people we care for together can enjoy life to its fullest, even as they confront the difficult realities of aging.” This sentiment only adds to the powerful message and direction contained in this wonderful book.

James K. Luiselli, Ed.D., ABPP, BCBA-D is a clinical psychologist in private practice and Adjunct Faculty in the School Psychology Program at William James College.